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N. G. Anderson, J. M. Googe, M. D. Zimmerman; Intravitreal Bevacizumab for Primary Therapy in Treatment-Naive Choroidal Neovascularization Due to Ocular Histoplasmosis. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5117.
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Ocular Histoplasmosis Syndrome (OHS) is thought to be a late sequela of systemic infection by Histoplasma capsulatum. One of the complications of OHS is the development of choroidal neovascularization (CNV). The natural history of CNV due to OHS typically involves severe vision loss, with 69% of eyes with juxtafoveal or subfoveal CNV having a visual acuity of 20/200 or worse after 39 months of follow-up. Historically, treatment for CNV due to OHS has been unsatisfactory. The Macular Photocoagulation Study showed that patients with extrafoveal and juxtafoveal CNV due to OHS benefited from thermal laser treatment, but the benefit was limited due to scotoma formation, recurrence, and persistence. Submacular surgery has show to be of only limited benefit. Photodynamic therapy has shown to be somewhat effective in treating CNV due to OHS. Recent, small, studies have demonstrated a benefit from intravitreal bevacizumab for CNV due to OHS, although many of the patients were previously treated with other forms of therapy. The purpose of this study is to evaluate the efficacy of intravitreal bevacizumab as primary therapy for treatment-naïve CNV resulting from OHS.
Chart review of 35 eyes of 35 consecutive treatment-naïve patients who underwent intravitreal injection of bevacizumab for primary treatment of CNV due to OHS. Outcome measurements included pretreatment and postreatment visual acuity (VA) and optical coherence topography (OCT) central macular thickness.
The average pre-treatment logarithm of the minimum angle of resolution (logMAR) VA was 0.57. The average final logMAR VA was 0.38. The average improvement in logMAR VA was 0.18. The average duration of follow-up was 49.4 weeks. The average number of injections was 3.7. Twenty-four patients (69%) showed improved VA, six patients (17%) did not experience any change in VA, and five patients (14%) experienced a decline in the VA. The average pre-treatment central macular thickness was 288 microns. The average post-treatment central macular thickness was 229 microns. The average improvement in central macular thickness was 43 microns. There were no cases of endophthalmitis, traumatic cataract, or retinal detachment in the series.
Intravitreal bevacizumab appears to be an effective treatment for CNV due to OHS. Most patients experienced improved or stabilized VA with treatment. The treatments were well tolerated with no serious adverse events.
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